Provider Demographics
NPI:1730486416
Name:PLAZA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:PLAZA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SQUAD LEADER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-497-3766
Mailing Address - Street 1:308 4TH AVE.
Mailing Address - Street 2:
Mailing Address - City:PLAZA
Mailing Address - State:ND
Mailing Address - Zip Code:58771-0057
Mailing Address - Country:US
Mailing Address - Phone:701-497-3766
Mailing Address - Fax:701-497-3779
Practice Address - Street 1:308 4TH AVE.
Practice Address - Street 2:
Practice Address - City:PLAZA
Practice Address - State:ND
Practice Address - Zip Code:58771-0057
Practice Address - Country:US
Practice Address - Phone:701-497-3766
Practice Address - Fax:701-497-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport